CN1747681A - Guided retractor and methods of use - Google Patents

Abstract

The present invention provides methods and apparatus in which a surgical retractor comprises a plurality of mechanically coupled tissue retaining walls that are guided into position along one or more guides previously implanted into the patient. The walls are preferably coupled by pivots, so that separating some of the walls from one another opens an operating space. There are preferably two guides, which are driven or screwed into the pedicles of vertebrae, or other bone. Since practical considerations will usually mean that the guides are completely parallel to one another, the retractor has oversized channels to receive the guides. The channels are best disposed in a frame, which also serves to hold lock the walls apart. Various convenience features are contemplated including a web disposed between the walls, which expands as the walls are separated. Also contemplated are projections from near the bottoms of one or more of the walls, which can alternatively or additionally help to hold the underlying tissue in place.

Description

Guided retractor and using method

Technical field

The field of the invention is a surgical retractor.

Background technology

Known polytype surgical retractor.The simplest device is piped probe, or the probe on subsidiary blade or other flat a little surface.The nearest embodiment of this notion has been described in the United States Patent (USP) 6206826 in (March calendar year 2001) such as Mathews.More complicated traction apparatus utilizes shears, bowstring, or screw-jack expanders, and it relies on the blade movement of coupling.These traction apparatuss have and can be locked in the appropriate position blade, keep surgical at least one hands and freely are used for other active advantage.For example referring to the United States Patent (USP) 6471644 in Sidor (in October, 2002).Yet other traction apparatus is the oneself to be opened, and comprises the United States Patent (USP) 6162172 (in December, 2000) of Cosgrove etc.The patent of all references is introduced by reference herein.

Although be undoubtedly aspect a lot usefully, above-mentioned traction apparatus neither one easily is fixed on the suitable position with respect to one or more skeletons.The United States Patent (USP) 5027793 of Engelhardt etc. (in July, 1991) is by being equipped with spike on the bottom of retractor wall, and the spike that can pierce skeleton further is provided, and solves the sort of needs in a way.Using to the resection operation zone up to skeleton of expection settled traction apparatus, beats traction apparatus and spike subsequently and enters suitable position.

Yet the problem of leaving over is that the excision that need be positioned properly traction apparatus may cause sizable damage to overlaying on tissue top and on every side.Another problem need to be a plurality of traction apparatuss to keep pushing from different directions the tissue of operative region.For example, the traction apparatus of Engelhardt etc. needn't address this problem, because preferably be applied as the acetabular bone operation, wherein main intrusion is from gluteus muscle, and they are high more a lot of than surgical location.

In spinal column and some other operations, these problems may be especially serious.Therefore, still need to provide operative space to reduce damage simultaneously with respect to concrete anatomical area location and the method and apparatus of opening to surrounding tissue.

Summary of the invention

For this target, the invention provides method and apparatus, wherein surgical retractor comprises that the tissue of a plurality of mechanical connections keeps wall, its guider along one or more previous implant patients is directed into the position.

Preferred embodiment is utilized two main walls and four less walls, and one on each of the end of two main walls.In such an embodiment, all walls are by pivot coupling, make the face of two main walls can be each other towards or leave mobile, to open or close operative space.The face of main at least wall is preferably flat, but can be any other suitable shape, comprises convex surface.The present invention is particularly suited for performing the operation on the arc bone surface or near the arc bone surface, and the bottom of wall can be (promptly advantageously being suitable for cooperating and/or meeting following bone surface) that adapts to.

Two preferred guiders are arranged, and it creeps into or pedicle of vertebral arch (pedicle) or other skeleton of precession vertebra.Various guiders can be implanted different skeletons, or the different zone of same skeleton.Because actual consideration means that usually guider is not parallel each other, traction apparatus has the groove amplified holding guider, but and guider should multiaxis with respect to pedicle of vertebral arch to moving.The cross section of groove can be circular, but more preferably elongation is the shape of oval or other trough of belt.

Groove is preferably disposed in the framework, and it also is used for keeping latch wall separately.Any suitable device can be used for removing main wall to open operative space, for example comprises simple chock or T shape rod, or is arranged on the mechanism on the framework.Framework can pass through tinsel, nut, clip, or the like keep in place with respect to guider.

The multiple characteristic easily of imagination comprises the net that is arranged between the wall, and net stretches when wall separates.Net can be cut, and tears, and bending, or other operation are to expose following tissue.And, help following tissue is remained on original position alternatively or additionally from the protrusion of imagining near the bottom of one or more walls, and similarly can go from corresponding wall shift in any suitable manner.The other parts of framework or traction apparatus can be transparent, to help the surgeon visual.

These and other target of the present invention and feature will become clear more fully from following description and appended claims, or can understand by the realization of the invention of setting forth below.

Description of drawings

For further illustrating above the present invention and other advantage and feature, the specific embodiment of the present invention by shown in reference to the accompanying drawings provides more detailed description of the present invention.Will be appreciated that these figure only describe the typical embodiment of the present invention, therefore do not think the restriction of the scope of the invention.By using accompanying drawing to describe and explaining further feature of the present invention and details, wherein:

Fig. 1 is the perspective view of the structure of opening of the traction apparatus of content according to the inventive subject matter.

Fig. 2 is the perspective view of the traction apparatus of Fig. 1, be set to close and structure.

Fig. 3 is patient's the back and the perspective view of spinal column, wherein uses finger to cut the pedicle of vertebral arch of location vertebra open.

Fig. 4 is the horizontal sectional view of vertebra, shows to use awl that guide hole is squeezed into pedicle of vertebral arch.

Fig. 5 is the horizontal sectional view of the vertebra of Fig. 4, and wherein screw is just in the hole of precession Fig. 4 manufacturing.

Fig. 6 is patient's the back and the perspective view of spinal column, and wherein the traction apparatus of Fig. 2 closure is installed on the guider of implanting adjacent vertebrae.

Fig. 7 is patient's the back of Fig. 6 and the perspective view of spinal column, and wherein traction apparatus is by opening TO.

Fig. 8 is patient's the back of Fig. 6 and the perspective view of spinal column, and wherein traction apparatus is opened, and removes net to expose various finger pieces and following tissue.

Fig. 9 is patient's the back of Fig. 6 and the perspective view of spinal column, and wherein traction apparatus is opened, and has removed various finger pieces (keeper is organized in the bottom).

The specific embodiment

The present invention pays close attention to new surgical retractor and correlation technique, compares with optional scheme, and its operative space that allows the surgeon to establish usefulness reduces the amount to the surrounding tissue damage simultaneously.

This reaches by the retractor system that is roughly linearity configuration when being preferably in closure state is provided, by meaning like this when the time in make position, when retractor system has from top observation than the wide a lot of aspect ratio of its thickness.This allows retractor system to be placed on the zone of relatively easy traction, and causes useful operative region to form when it moves on to the position of opening.

For traction apparatus of the present invention, current preferred use is relevant with lumbar surgery, and discussion subsequently will use it as an example.Yet should understand equipment of the present invention and method can be applied to other use to useful result.

Fig. 1 is total illustrates traction apparatus 10, and it has the framework 20 as retractor body.In the embodiment in figure 1, traction apparatus 10 is equipped with main wall 32A, 32B and accessory wall 34, and they are bound up by six hinges 36.Fig. 1 illustrates the traction apparatus 10 at open position, and it defines operative space 50.Be equipped with locking/opening mechanism 40 to keep traction apparatus in position that needs are opened.

According to concrete application, framework 20 can be any suitable dimensions and shape, and bigger framework is more useful to bigger otch usually.For the low back surgical operation on the adult, the overall dimensions of this preferred framework is approximately the degree of depth of 5.5cm, the length of 3.5cm, the width of 3.0cm.Framework 20 can be made with any suitable material, especially the nontoxic polymer such as polyethylene.Framework 20 can advantageously be coated color reducing from the dazzling light of operating room illuminator, and some or all of framework can be transparent relatively.

Framework 20 can comprise handle portion 22 and operative space 50 periphery 24 on every side that connects with locking mechanism 40.Locking mechanism 40 is shown as ratchet structure, but will recognize and can use other locking mechanism, and especially those provide the locking mechanism of highly reliable and processing ease.In an illustrated embodiment, wall 32A, 32B, at least one in 34 is preferably for example by using pin (not showing) to be attached to periphery 24.

Groove 26 is positioned on periphery 24 the opposite flank, and each is sized to and holds one of guider 172 (referring to Fig. 4-9).Native system is designed to use pedicle screw or other bone fixation systems of wide region, and the guider work of many quantity, and no matter the physical relationship between screw and the guider.The passage that limits by groove 26 preferably relatively the external diameter of the axle of guider 172 amplify, make groove 26 can easily hold uneven or each other and/or with groove can not complete matching the guider 172 of some alternate manners.In a preferred embodiment, groove limits has about 5 passages to the 15mm diameter, and guider 172 (referring to Fig. 5,6) preferably has corresponding about 4 to 6mm diameter.Chen Shu all scopes are understood to include end points herein.

The same with other parts, various wall 32A, 32B, 34 the most handy biocompatible materialses are made, and depend on the surgical operation place of using them herein, and they also can have any suitable dimensions and shape.Wall 32A, 32B, 34, for example, can in vertical cross-section common rectangle as shown, main at least wall 32A, the bottom bend of 32B is to adapt to special skeletal shape, such as the shape of the vertebra vertebral plate in the spinal surgery.Also imagine main at least wall 32A, the bottom of 32B can be flexible, down to outstanding with depression the conforming to of small part with lower floor's skeleton.Wall 32A, 32B, 34 are illustrated as in the drawings and have flat side, but selectablely can outwards bend (protruding), and inwardly bow (recessed) maybe can have any other suitable horizontal cross-section.

One or more (not show) of wall even can be expansible are made by the air bag that limits opening.Certainly, wall 32A, 32B, 34 must be enough firm, therefore enough thick, to stand the power of expection placed on it. Wall 32A, 32B, 34 preferably not too thin so that their tissues below during launching, cutting, but the size that should too thick so that greatly not hinder operative region.With shown in the relevant current preferred thickness of embodiment at thickest point from about 3.5mm to about 5mm, the thickness at the about 1.5mm-3mm in the bottom of each wall is reduced in attenuation gradually.Wall also can be nested in any suitable manner, and its part that means a wall is simply extended around the part of another wall.

Hinge 36 is as wall 32A, and 32B is among the embodiment shown in 34 prolongation is shown in.In fact all walls and hinge can be molded as single parts, and each of hinge 36 is as the thin especially drape forming of wall.This of hinge type is so-called " hinges ", and it can handle a plurality of openings when making with the suitable material such as polypropylene.Other configuration that can use hinge will be recognized.For example, replace four accessory walls 34, main wall 32A, 32B can be at every end by the only parts of the flexibility of single outside bow (not showing) connection.Certainly the sum of wall can be greater than or less than 6.

The term of Shi Yonging " wall " has very wide significance herein, means the tissue retaining barrier of any kind of, and is wideer than thickness usually, and has useful height for the expection use.Can cave in or be recessed in the side of wall, have as the side of wall that mesh coating (not showing) can occur, and the side can even have through hole (not showing).

Because the shape of illustrated embodiment closure is very linear shape when from the perspectives in the zone that will draw, the embodiment shown in the traction apparatus 10 can be referred to as " linear distractor ", with the some traction apparatus differentiation that be the pipe of circle substantially.This term does not mean that any one that make as a whole traction apparatus or wall must be linear, and term does not mean that wall is very thin yet so that constitutes cutting edge.The use of as directed linear distractor is characterised in that wall has roughly the same contour at closed and open position, and the design of " hinges " and arrange the shape of controlling operative region between period of traction.This design is considered to have multiple advantage, comprise along the distribution of the pressure of the tissue that will draw, the operative space of the closure of controlled dimensions and shape, and wide relatively operative space, it allows the surgeon to have the direct visuality of confined surgical areas and the space of manipulation of surgical instrument.

Locking/opening mechanism 40 shows that as typical ratchet type of mechanism it has tooth 44 and releasing device 46.Framework 20 can have locking mechanism and opening mechanism (not showing), or independent any.A large amount of other locking known in the art and/or opening mechanism, other probably also become in the future known.Expectation can be used any suitable locking and/or opening mechanism.

Operative space 50 depends on the size and dimension of wall, and wall be separated from each other certain degree will be bigger or less.The preferred zone of operative space 50 that is used for lumbar surgery is at about 7cm ²And 14cm ²Scope in.

Fig. 2 is total illustrates Fig. 1 traction apparatus 10 that is set to closed configuration.Term " closure " about the configuration of traction apparatus 10 is relative with " opening ".Therefore, closure only means roughly closed, but does not require fully and close, so wall 32A, 32B is arranged side by side.In make position, wall 32A, 32B can be separated into 1mm or more well.Similarly, in the configuration of opening of imagination, wall 32A, 32B may separate 1.5cm at least, but the use that depends on expection can be separated into 2.3cm or more.

The part of the spinal column that illustrates patient 100 that Fig. 3 is total, wherein paravertebral muscles is with 110,112 schematically to indicate respectively by translucent.Spinal column 100 comprises vertebra 120, and each vertebra comprises transverse process 122, spinous process 124 and pedicle of vertebral arch 126.Done otch 130, the finger 142 of hands 140 is used for cutting muscle open and locatees in the pedicle of vertebral arch 126 one.Certainly, chock, probe or other instrument can be used for replacing finger or locate pedicle of vertebral arch except that finger 142.

Fig. 4 is total illustrates sleeve pipe 150, and its location is used for producing the awl 152 or the probe in holes 160 in pedicle of vertebral arch 126.Awl 152 can manually promote or advance past in addition the cortex 127 of pedicle of vertebral arch.But sleeve pipe 150 the most handy ray permeable materials such as plastics or carbon fiber are made, and awl 152, it is the most handy such as surgical steel to reach other attachment and insert, the metal of titanium and so on, or other is durable, and the radiation opaque material is made.Can be by fluoroscopy or other visualization technique assist location sleeve pipe 150.

In a preferred method, remove awl 152, longer, thinner probe (not having to show) inserts the softer bone marrow 128 of the main body 129 of vertebra 120 by pedicle of vertebral arch.Remove long probe subsequently, show that in Fig. 5 screwdriver 176 is used for inserting screw 174.Shown screw is equipped with 170, and it keeps guider 172 in place.Remove screwdriver 176 subsequently, stay screw 174 and implant vertebra 120, and guider 172 is attached to the top of screw 174 with multiaxis, mean that in this way guider moves freely in the zone of the conical surface that limits the end that is dissipated into screw from the tip of adnexa, and the longitudinal axis of the axis of the conical surface and screw is coaxial.Repeat this process another zone so that another screw and relevant guider 172 are inserted skeleton, under the situation of spinal surgery, the pedicle of vertebral arch of the higher or lower vertebra that this another zone most likely is right after on the same side.In other surgical operation, (do not show), second, or possibility even other guider, may as first guider that holds, insert the different position of same skeleton.

In Fig. 6, the guider 172 of implanting adjacent vertebrae 120 has inserted in the groove 26 of closed retractor 10.The width of the multiaxial motion of guider and the increasing of groove makes that inserting guiders by groove 26 becomes simple thing, though the width of groove not in full conformity with contiguous interpediculate width, or the screw orientation is not parallel each other.Those skilled in the art will recognize groove except that in the drawings those of demonstration in this area, can have other configuration, and may be multi-level rather than simple single levels.

Fig. 8 and Fig. 9 show guider can be equipped with receive auxiliary grappling framework 20 to the guider 172 wing nut or the screw thread 190 of other corresponding threaded parts 192.In optionally disposing, one can be used the Lock Part that does not have screw thread such as fingers 193.Place template (not showing) on the top of framework but another optionally is configured in, and can use wing nut, fingers, or other hold down gag keeps template in place.Framework also can be used for keeping other device, and such as suction or illuminator, these devices are introduced zone 50 and kept in place by the hookups on the framework 20.To recognize that guider needs long enough fully to extend through groove to allow them, hold suitable hold down gag, and make retractor body can pull down on the end of relevant pedicle screw to allow guider.

In Fig. 7, traction apparatus 10 illustrates with the step of opening by dilator 180, and dilator can manually insert between the relative wall, to produce and to widen gap between them.In the figure, dilator generally includes the chock with handle.Dilator 180 is more desirable than using no auxiliary finger, because it has mechanical advantage.Alternatively, traction apparatus can be opened by using finger, such as using handle 22 and framework 20 by the method for using the thumb power opposite with finger.There are many optional methods to comprise or do not comprise any mechanical advantage, comprise the T shape handle (not demonstration) that for example is attached to axle and cam.

In order to minimize injury, open traction apparatus providing bigger, but only big a little working region is wished for some processes than the distance between the corresponding contiguous pedicle of vertebral arch to the tissue in the waist operative region.However, it should be understood that and to open traction apparatus, and traction apparatus can be designed as the bigger degree of distance that arrives pedicle of vertebral arch than pedicle of vertebral arch that is opened to distance less than the distance between the corresponding contiguous pedicle of vertebral arch.It is enough big that traction apparatus 10 should be configured so that to allow it to open, and needs operative space with formation.Alternatively, traction apparatus can be configured to prevent its overdistension.If desired, can provide the traction apparatus of different size to allow to select to provide the minimum possible traction apparatus of sufficient operative space.

In Fig. 8, traction apparatus 10 has been opened to appear and has been positioned at wall 32A, the optional net 12 between the 32B and 34.Net 12 is preferably photoplate or other biocompatible plastic sheet of thin flexibility, and it can cut easily, tears, or breaks to expose the part that following tissue 105 is wished with some alternate manners, prevents other tissue intrusion work space simultaneously.Net 12 is shown as the whole bottom surface that covers operative space 50, but can cover less space alternatively, and can be between different walls or middle the stretching, extension.

Fig. 8 also illustrates and keeps finger piece 14 optionally to use, and it is illustrated as extension below net 12, or spins out below net 12, although some or all of finger piece 14 can be positioned at alternatively net 12 above.Preferably, finger piece 14 can be made with malleable material, make them can be used for drawing one nerve, or other is by the anatomical elements of surgeon's mechanical arrangement.

In Fig. 9, traction apparatus 10 is shown as the position of opening, and many unnecessary finger pieces 14 are illustrated as from operative space and remove.Can finish this removing in any manner, comprise by cutting (as using dissecting knife or shears), by hands or tool using bending, or the like.Wide finger piece is arranged, narrow finger piece, long or short finger piece, the finger piece at tight spacing or broad interval, finger piece flat or rounding, or other configuration, its use for expection is useful.Use the place of finger piece, they can be molded as the continuous extension of wall or they can be fixed on the wall in some mode.Taking malleable material also to use the coated materials finger piece of wall, thereby they are integrated in the wall, make them can utilize for position traction independent in the operative region simultaneously, also is possible.

The preferable methods of tissue retractor 10 being inserted patients comprises these steps: provide and have paired tissue retraction surface (such as at wall 32A, 32B is on 34), and the traction apparatus 10 of the first and second guider housing regions (such as groove 26); Through skin or in addition the zones of different of first and second guiders (such as guider 172) implant patient skeleton; The location is by the upper end of first and second guiders of the first and second guider housing regions respectively subsequently, and then inserting traction apparatus fully along guider enters patient, the muscle of riving effectively; And last moving tissue traction surface is separated from one another to open operative space.These methods are that the place of screw is particularly useful at one or more guiders, and screw is implanted in the very clear and definite anatomical structure such as pedicles of vertebrae.The method of imagination is also very useful in opening the operative space that covers adjacent bones.Particularly preferred method is used nut alternatively, clip, or other that can be attached easily and fixable mechanism, with stablize on the guider traction apparatus 10 also/or drop-down traction apparatus to the end of relevant pedicle screw.

From top description, should be understood that now the method and apparatus of the novelty that discloses changes conventional distraction procedure at its head herein.Replace the location to keep wall or a plurality of maintenance wall also subsequently by keeping spike or pillar implantation skeleton it in place, as carrying out before the present invention, this process is implanted guider, uses the positioning towed device of guider subsequently.Certainly, at first positioning towed device, it is possible placing guider subsequently, and the invention provides the useful improvement that is used for this optional method.

The advantage of change process is great.Except other situation, this new process allows the surgical location exactly positioning towed device 10 of surgeon in expection, because the location can accurately be finished with respect to following skeletal structure (for example pedicle of vertebral arch 126 of vertebra).Screw is implanted the surgeon needs their place, and the guider 172 guiding traction apparatuss that are attached to screw head enter the anatomical tissue of hope downwards, the muscle of riving, and, limit surgical locations 50 in the 32B and 34 at wall 32A.Surgical location 50 is opened subsequently, gives the exposure that the surgeon need carry out operating hope, and not hyper-traction and cause disorganization.

Another advantage is that these new method and apparatus have quickened process and used resource more efficiently with respect to prior art.Except other situation, after placing guider 172 and screw 174 and traction apparatus 10 attachments and opening, no longer need fluoroscopy, it can be moved along to different rooms.

Another advantage has appearred from the use of linear distractor.When being in the close position, find thin but wide device is placed easily at operative region, and because its along the linearity anatomical features of riving, such as muscle, linear distractor provides very useful operative space when at open position.One of the present invention is characterized as traction apparatus minimum degree ground and invades, and visually observes surgical location and does operating useful shape simultaneously but enough big operative space is provided and has the permission surgeon.This is the significant improvement that surpasses tubular retractor.

Another advantage that also has comprises reducing of convenient and surgeon's pressure.Novel method and apparatus loosens the surgeon mentally more.After screw 174 enters, in the first of process, about open surgical location other anything all very simple.This helps the surgeon to loosen mentally with on the health.

Thereby, disclosed the specific embodiment and the application of novel traction apparatus.Yet those skilled in the art should be understood that those except having described in this area, and this is in a lot of bigger changes of the situation that does not depart from inventive concept is possible.Therefore, the subject matter of an invention content constraints is in the spirit of appended claims.And when interpreting both the specification and the claims book, all terms should be explained in the mode of maximum possible consistent with the context.Especially, term " comprises " and " comprising " should be interpreted as referring to the unit in not exclusive mode, parts or step, the unit quoted of indication, parts, or step can propose, or utilize, or with other the unit of not quoting especially, parts, or step combination.

Claims (28)

1. retractor system, it comprises:

A. the retractor body that has make position and open position, described make position presents the shape of substantial linear, place closed retractor body to change places in the area contents that will draw, and described open position provide greater than, but the working region that only is a bit larger tham the distance between the corresponding contiguous pedicle of vertebral arch in the described zone that will draw, and described retractor body has the groove of two elongations;

B. be used to be attached to each a pair of pedicle screw of the pedicle of vertebral arch of described corresponding vicinity, and a pair of guider member that engages with separately pedicle screw multiaxis, make the guider member have the range of movement that limits the conical surface with respect to the longitudinal axis of described screw, each of described guider member has enough length and passes through in retractor body corresponding groove to allow it, and each guider member has and is used to leave behind the relevant attachment member of retractor body to the end of relevant pedicle screw; And

C. described retractor body forms single parts and has active hinge, it allows from the position of closure to the motion of open position, surround described working region simultaneously when at open position fully, the periphery of described retractor body is roughly the same in closed and open position.

2. retractor system as claimed in claim 1, also comprise the net that strides across the bottom of operative space when traction apparatus during at open position, described net be with removing in the zone of hope, but can prevent in other zone that unnecessary tissue from invading the material of operative space and making.

3. retractor system as claimed in claim 1 comprises that also at least one is used in the finger piece that allows in the operative region its material that is used for drawing anatomical elements to make.

4. retractor system, it comprises:

A. the retractor body that has make position and open position, described make position presents the shape of substantial linear, places closed retractor body to change places in the area contents that will draw;

B. be used to be attached to a pair of pedicle screw of pedicle of vertebral arch; And

C. a pair of guider member that engages with separately pedicle screw multiaxis makes the guider member have the range of movement that limits the conical surface with respect to the longitudinal axis of described screw.

5. retractor system, it comprises:

A. the retractor body that has make position and open position, the periphery of described main body is roughly the same in closure and open position, and described main body comprises its hinge that moves of a plurality of permissions between described open and close position;

B. be used to be attached to a pair of pedicle screw of pedicle of vertebral arch; And

C. a pair of guider member that engages with separately pedicle screw multiaxis makes the guider member have the range of movement that limits the conical surface with respect to the longitudinal axis of described screw.

6. retractor system as claimed in claim 5, wherein retractor body is formed by single parts.

7. traction apparatus, it comprises:

A. first tissue that is attached to the first guider holding tank keeps wall; And

B. being attached to first tissue movably keeps second tissue of wall to keep wall.

8. traction apparatus as claimed in claim 7, each that wherein keeps wall has generally flat side.

9. traction apparatus as claimed in claim 7, wherein first and second keep wall nested relative to each other.

10. traction apparatus as claimed in claim 7 wherein keeps in the wall at least one to have crooked bottom margin.

11. traction apparatus as claimed in claim 7 wherein keeps in the wall at least one to have the bottom margin of adaptation.

12. traction apparatus as claimed in claim 7 also comprises the hinge that connects the first and second maintenance walls.

13. traction apparatus as claimed in claim 7 also comprises having the framework that keeps the mechanism that this maintenance wall is separated from each other.

14. traction apparatus as claimed in claim 7, wherein the first guider holding tank comprises slit.

15. traction apparatus as claimed in claim 14 also comprises the second guider holding tank, wherein two guider holding tanks all are arranged in the framework.

16. traction apparatus as claimed in claim 15, the wherein band of at least one in guider holding tank slit.

17. traction apparatus as claimed in claim 7, wherein at least a portion of traction apparatus is roughly transparent.

18. traction apparatus as claimed in claim 7 also comprises connecting the net that keeps the wall distal portions.

19. traction apparatus as claimed in claim 7 also comprises a plurality of movably finger piece processes of extending from the distal portions of the first maintenance wall.

20. a retractor system comprises traction apparatus as claimed in claim 7, and the at one end definite size of first guider and big or small for to be received in the first guider holding tank, and the first area of inserting skeleton at the other end.

21. retractor system as claimed in claim 20, wherein first guider keeps in place with respect to skeleton by screw.

22. retractor system as claimed in claim 20 comprises that also the clip or the nut of cooperating with first guider keep framework in place with auxiliary phase for skeleton.

23. retractor system as claimed in claim 20, wherein traction apparatus has the second guider holding tank that separates with the first guider holding tank, and comprise at one end definite size and size, and insert second guider of the second area of skeleton at the other end in the second guider holding tank, to be received.

24. retractor system as claimed in claim 20 also comprises the dilator with handle and inclined wall.

25. one kind is inserted patient's method to tissue retractor, it comprises:

A., traction apparatus with paired tissue retraction surface and first and second guider housing region is provided;

B. first and second guiders in the zone of the zones of different of the skeleton of skin implant patient;

C. locate the upper end of first and second guiders subsequently by the first and second guider housing regions respectively, traction apparatus is inserted in patient's the tissue; And

D. the moving tissue traction surface is separated from one another.

26. method as claimed in claim 25, wherein implantation step comprises the pedicle of vertebral arch of the first guider precession vertebra.

27. method as claimed in claim 25, wherein implantation step comprises the different skeleton of first and second guiders insertion.

28. method as claimed in claim 25 also comprises and uses tinsel to stablize traction apparatus on guider.

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